Between September 1985 and December 1993 280 patients suffering from e
sophageal cancer underwent treatment at the department of general and
abdominal surgery at the University of Mainz. Of the 167 patients oper
ated, 152 patients had an esophageal resection performed in 113 cases
as abdominothoracic resection and in 39 cases via the transmediastinal
approach. 104 patients were curative resected (R0). Recurrence-free a
nd total survival were correlated to the extent of the mediastinal lym
ph node dissection supposing comparable operative stress. The mean rec
urrence-free and the mean total survival after abdominothoracic resect
ion with 2-field lymph node dissection were 42.4 months resp. 47.3 vs.
18.9 months resp. 25.2 months after transmediastinal resection (p = 0
.015 and p = 0.035). We suggest a differentiated surgical approach con
cerning abdominothoracic resection with 2-field lymph node dissection
for limited tumor size (pT1-3 pN0-1 M0), if the operative risk is tole
rable. The transmediastinal resection appears to be only enough radica
l in cases with early tumor stages (UICC 0-I) and also is advantageous
for risk patients with simultaneously more advanced tumor (palliative
resection), because of the lower operative stress.